The epidemiology of rapid response team activation amongst patients undergoing major gastrointestinal surgery |
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| Affiliation: | 1. Austin Health, Melbourne, Australia;2. School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia;3. Melbourne Medical School, The University of Melbourne, Melbourne, Australia;4. CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;5. Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia;6. Melbourne Academic Centre for Health, Melbourne, Australia;7. General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Melbourne, Australia;8. Department of Surgery, The University of Melbourne, Australia;9. Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia;1. Department of Emergency, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China;2. State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, General Hospital of People''s Liberation Army, Beijing, 100853, China;3. National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China;4. Department of Interventional Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, People''s Republic of China;5. Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China;6. Department of Emergency Medicine, General Hospital of Northern Theatre Command, 83 Wenhua Road, Shenyang 110016, China;7. Medical Information Center, Chinese PLA General Hospital, Beijing, 100853, China;8. Department of Emergency, Hainan Hospital of Chinese PLA General Hospital， Sanya, 572000, China;1. School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia;2. Metro North Hospital and Health Service, Queensland, Australia;3. Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia;4. School of Nursing and Midwifery Griffith University, Queensland, Australia;5. Paediatric Intensive Care Unit Queensland Children''s Hospital, South Brisbane, Queensland, Australia;6. School of Medicine, University of Queensland, St Lucia, Queensland, Australia;7. Paediatric Intensive Care Unit, Royal Children''s Hospital, Melbourne, Victoria, Australia;8. Murdoch Children''s Research Institute, Victoria, Australia;9. Department of Paediatrics, University of Melbourne, Victoria, Australia;10. Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Australia;11. School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia;12. Department of Anaesthesia and Pain Management, Queensland Children''s Hospital, South Brisbane, Queensland, Australia;13. Perioperative & Critical Care Center for Outcomes Research (PC-CORE), USA;14. Department of Anesthesiology, Critical Care & Pain Medicine, Division of Critical Care Medicine, Boston Children''s Hospital, USA;15. Harvard Medical School, Boston, USA;p. Infection Management, Princess Alexandra Hospital, Woolloongabba, Qld, Australia;q. School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia;1. Queensland Children''s Hospital, 501 Stanley Street, South Brisbane, QLD 4101, Australia;2. The Queensland University of Technology, 2 George Street, Brisbane City, QLD 4000, Australia;3. School of Medicine, Deakin University, 75 Pigdons Rd, Geelong, VIC, 3216, Australia;4. Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Royal Brisbane & Women''s Hospital, Building 16/901, Herston, QLD, 4029, Australia;5. General Practice, Junction Street Family Practice, Nowra, NSW, Australia;1. Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia;2. Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, Sydney, Australia;3. Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia;4. Division of Critical Care, The George Institute for Global Health, University of New South Wales, Sydney, Australia;5. Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia;6. ANZIC Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia;7. Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Division of Critical Care, The George Institute for Global Health, University of New South Wales, Sydney, Australia;8. Nepean Clinical School, University of Sydney and Senior Staff Specialist, Nepean Hospital, Australia;9. Physiotherapy Department, St Vincent''s Hospital, Sydney, Australia |
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| Abstract: | BackgroundClinical deterioration requiring rapid response team (RRT) review is associated with increased morbidity amongst hospitalised patients. The frequency of and association with RRT calls in patients undergoing major gastrointestinal surgery is unknown. Understanding the epidemiology of RRT calls might identify areas for quality improvement in this cohort.ObjectivesThe objective of this study is to identify perioperative risks and outcome associations with RRT review following major gastrointestinal surgery.MethodsWe conducted a retrospective cohort study using electronic databases at a large Australian university hospital. We included adult patients admitted for major gastrointestinal surgery between 1 January 2015 and 31 March 2018.ResultsOf 7158 patients, 514 (7.4%) required RRT activation postoperatively. After adjustment, variables associated with RRT activation included the following: hemiplegia/paraplegia (odds ratio [OR]: 8.0, 95% confidence interval [CI]: 2.3 to 27.8, p = 0.001), heart failure (OR: 6.9, 95% CI: 3.3 to 14.6, p < 0.001), peripheral vascular disease (OR: 5.3, 95% CI: 2.7 to 10.4, p < 0.001), peptic ulcer disease (OR: 4.2, 95% CI: 2.2 to 8.0, p < 0.001), chronic obstructive pulmonary disease (OR: 4.0, 95% CI: 2.2 to 7.2, p < 0.001), and emergency admission status (OR: 2.6, 95% CI: 2.1 to 3.3, p < 0.001). Following the index operation, 46% of first RRT activations occurred within 24 h of surgery and 61% had occurred within 48 h. The most common triggers for RRT activation were tachycardia, hypotension, and tachypnoea. Postoperative RRT activation was associated with in-hospital mortality (OR: 6.7, 95% CI: 3.8 to 11.8, p < 0.001), critical care admission (incidence rate ratio: 8.18, 95% CI: 5.23 to 12.77, p < 0.001), and longer median length of hospital stay (12 days vs. 2 days, p < 0.001) compared to no RRT activation.ConclusionAfter major gastrointestinal surgery, one in 14 patients had an RRT activation, almost half within 24 h of surgery. Such activation was independently associated with increased morbidity and mortality. Identified associations may guide more pre-emptive management for those at an increased risk of RRT activation. |
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| Keywords: | Rapid response team Medical emergency team Clinical deterioration Postoperative complication Failure to rescue |
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